| Objective :This paper proposes to observe the clinical effect comparison of singlelayer fibular flap(skin)under the guidance of CAD / CAM technology in the reconstruction of mandible defect by later implant technology in the restoration of dentition defect with that of the conventional implant,and to analyze the clinical effect of fibula implant functional restoration of mandible under the guidance of CAD / CAM technology.Method :Experimental group:Five patients(3 males and 2 females)with mandible defect caused by mandible tumor were selected,who diagnosed in the department of Stomatology of Fuyang people's Hospital from 2015 to 2017.They aged from 26 to 66 years old,with an average age of 41.60 years.And there were 4 cases of mandible ameloblastoma and 1 case of mandible gingival carcinoma.This paper analyzed the imaging data of 5 patients with mandible tumor requiring large-scale mandible amputation,and used CAD / CAM technology to simulate the diseased mandible amputation and design the best fibula area to reconstruct the mandible defect.Inserted the concept of implant into the computer design,and maximized the natural width of fibula to restore the height of mandible,which creates favorable bone conditions for the later implant repair of dentition defects.Combined with rapid prototyping technology(RP),to print out the preoperative and postoperative entity models and surgical guide plates,and preformed the reconstruction titanium plate on the reconstructed entity model,then amputated the fibula,accurately shaped and fixed in sections under the condition of continuous pedicle.One year after the success of fibula transplantation,implanted 22 implants at the same time as the titanium plate was removed and reconstructed.Review CT after 4-6 months,and designed the personalized combined crown with sanitary bridge to complete the dentition reconstruction after confirming the ideal combination of implant and bone.Control group:Six patients(3 males and 3females)who were treated with implant prosthesis for dentition defects in the department of Stomatology of Fuyang people's hospital from 2017 to 2018 were selected,all of them were designed as implant crown with multiple teeth defects.Their age ranged from 29 to 60 years,with an average age of 40.83 years,and with total 23 implants.Asked the patients to have a regular follow-up visit,and recorded and counted the relevant data of two groups on the day of completion of repair and after further consultation,including crowntoimplantatio(C / I),masticatory efficiency and periodontal health around the implant,which include the change value of plaque index(PLI),bleeding index(BI)and marginal bone loss around the implant(MBL),all of them were analyzed by SPSS18.0,to analyze the significance of functional restoration of mandible with single vascularized fibular flap and implant on functional recovery and clinical promotion under the guidance of CAD / CAD technology.Results:1 The proportion of PI score 0 was 86.4%,PI score 1 was 13.6%,BI score 0was 77.3%,BI score 1 was 22.7% in fibula flap implantation group,compared with the control group,the frequency of plaque and gingivitis were slightly higher,but the difference was not statistically significant(P > 0.05);2 The average C/I of 23 implants for normal jaw implant was(1.21 ± 0.34),which was lower than that of the experimental group(1.75 ± 0.31);The difference was statistically significant.3 In the experimental group,the BML of the marginal bone around the implant was(0.3205 ± 0.31),(0.4659 ± 0.1081)in half a year and a year,which was slightly higher than that of the control group,but the difference was not statistically significant(P >0.05);4 The masticatory efficiency of the experimental group after fibula implantation was(51.43 ± 2.5),which was significantly lower than that of the control group,which was(63.79 ± 2.501).The difference was statistically significant(P < 0.05).Conclusion:1 The C/I of patients with single-layer fibula implants is larger than that of conventional jaw implants.2 Plaque index and bleeding index can also be better controlled in fibula implantation when oral hygiene is well maintained.3 Partial masticatory function can be restored by fibular flap transplantation and later implant repair for large mandibular defects,however,the masticatory efficiency of the implant is relatively low compared with that of the normal jaw implant.4 There was no significant difference in peripheral bone resorption between fibula implant and jaw implant.5 The C/I of single-layer fibula implant is higher,but it has no effect on accelerated bone absorption around fibula implant. |
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